Child Behavior

Asthma and Your Child

This publication was written by the
American Academy of Pediatrics to inform parents about asthma. It includes
information about asthma symptoms, triggers, treatments, medicines, and how to
communicate with your child's school.

What is asthma?

Asthma is a chronic disease of the airways in
the lungs. The airways are very sensitive and may be inflamed even though
symptoms are not always present. The degree and severity of airway irritation
varies over time. One of the most important goals of asthma treatment is to
control the irritation in the airways and the symptoms that result.

In an asthma "attack," the airways
become narrowed or blocked. The inner lining of the airways becomes inflamed
(swollen and irritated) and the outer muscles tighten around the airways, making
breathing difficult. The good news is that this can be treated and
controlled.

Who gets asthma?

Asthma is the most common serious chronic
disease of childhood. It is one of the main reasons children miss school and the
most frequent cause for hospitalization in children. In the United States,
nearly 1 out of every 10 children has asthma.

Many things can influence the onset of asthma
and include family history (children who have family members with allergies or
asthma), infections, exposure to allergens, exposure to tobacco smoke, and
exposure to air pollutants. Children with other types of allergic diseases
(eczema, food allergy, hay fever) also are more likely to develop asthma.

The number of children with asthma has been
increasing worldwide, and the amount of illness caused by asthma may also be
increasing in some parts of the country. The reasons for these increases are not
exactly known.

What are symptoms of asthma?

Symptoms of asthma can appear quickly or develop
slowly. Some children have symptoms of asthma often enough that they have to
take medicine every day. Other children may need medicine just once in a while.
Every child is different.

A cough may be the first and sometimes only
asthma symptom. Other symptoms may include

Wheezing (a high-pitched whistling
sound)

Difficulty breathing or shortness of
breath

Tightness in the chest

Decreased ability to exercise or
self-limiting exercise

How is asthma diagnosed?

There is no simple test to diagnose asthma.
It's often difficult to diagnose, especially in young children. Your
child's doctor will need to ask you specific questions about your
child's health and then a careful physical exam is done. The information
that you provide will help your child's doctor determine if your child
has asthma.

Does your child have symptoms such as
wheezing, coughing, or shortness of breath?

How often do the symptoms occur and how
bad do they get? For example, is your child missing school or unable to
participate in sports or other activities because of breathing problems?
Or is coughing or wheezing keeping your child up at night?

What triggers the symptoms or makes them
worse? (For example, with colds, exercise, smoke, allergens, or
stress/emotions?)

Is there a history of chronic runny nose
or eczema?

Which medicines have been tried? Did
they help?

Is there any family history of allergies
or asthma?

If your child is old enough (usually older than
5 or 6 years), your child's doctor may test your child's lung
function. One way to do this is with a machine called a
spirometer (which is different from a peak flow meter).
Spirometry measures the amount of air and how fast it can be blown out of the
lungs. Your child's doctor may also want to retest your child's
lung function after giving her some asthma medicine.

Some children don't feel better after
using medicines. If medicines don't work, tests may be done to check for
other conditions that can make asthma worse or have the same symptoms as asthma.
These conditions include allergic rhinitis (hay fever), sinusitis (sinus
infection), gastroesophageal reflux disease (GERD—heartburn), and vocal
cord dysfunction (spasms of the vocal cords or voice box).

Keep in mind that asthma can be a difficult
disease to diagnose, and the results of lung function testing may be normal even
if your child has asthma. For some children, the tendency to wheeze with colds
(or respiratory infections) goes away as their lungs grow.

How is asthma treated?

The goal of asthma treatment is to eliminate or
reduce symptoms so children can fully participate in normal physical activities.
This can be done by avoiding asthma triggers and providing asthma medicine.
It's also important to prevent emergency department visits and hospital
stays because of asthma attacks. If your child experiences asthma symptoms more
than twice per week, let your child's doctor know.

What are asthma triggers?

Certain things cause asthma
attacks or make asthma worse. These are called
triggers. It is important to find out what those triggers
are for your child and learn ways to help your child avoid them. Allergens and
irritants are triggers that can be found in your home, school, child care, and
relatives' homes.

Some common asthma triggers are

Allergens: These are things
to which your child might be allergic. Many children with asthma have
allergies, and allergies can be a major cause of asthma symptoms.

– House dust mites (tiny
"bugs" you cannot see that are commonly found in
bedding, carpet, and upholstered furniture)

– Animals with fur or
hair

– Cockroaches

– Mice

– Pollens (trees, grass,
weeds)

Infections of the lungs and sinuses

– Viral infections

– Bacterial infections,
such as pneumonia or sinus infections

Irritants in the
environment (air that you breathe)

– Cigarette and other
smoke

– Air pollution
(chemicals, smog, auto exhaust, etc)

– Cold or dry air

– Sudden changes in
weather

– Odors, fragrances,
chemicals in sprays, and cleaning products

– Unventilated space
heaters (gas or kerosene) and fireplaces

– Odors and gases
released from new carpets, furniture, or materials in new
buildings

Exercise (About 80%
of people with asthma develop wheezing, coughing, and a tight feeling in
the chest when they exercise or may develop prolonged cough or wheeze on
completion of exercise.)

Emotional stress (laughing
or crying hard)

How can triggers be avoided?

While you can't make your home completely
allergen- or irritant-free, there are things you can do to reduce your
child's exposure to triggers. This will help decrease symptoms as well as
the need for asthma medicines. The following tips may help:

Don't smoke.
Don't let anyone smoke in your home or car or around your child
(like at child care or at school).

Reduce exposure to dust mites if
your child is allergic to dust mites. Cover your
child's mattress and pillows with special dust mite–proof
covers. Wash your child's bedding in hot water every week. Remove
stuffed toys from the bedroom. Vacuum and dust often. Use a dehumidifier
to reduce indoor humidity to 30% to 50% (if possible).
Remove carpeting in the bedroom; bedrooms in basements should not be
carpeted.

Reduce exposure to pet
allergens. If your child is allergic to furry pets, remove
the pets from the home. If this isn't possible, keep the pets out
of your child's bedroom and keep the bedroom door closed. You may
also consider a high-efficiency particulate air (HEPA) filter in the
bedroom or on the furnace. Although these interventions may reduce pet
allergen levels some, they are much less effective than finding the pet
a new home.

Control cockroaches. If you
have a roach problem, always use the least toxic method to control them.
For example, you should repair holes in walls or other entry points, set
roach traps, and avoid leaving out exposed food, water, or garbage.
Avoid bug sprays and bombs, as these could trigger an asthma attack. If
these measures fail, you may need to consult a licensed pest control
professional.

Control mice. If you have
seen mice or signs of mice in your home, several steps can be taken to
control them. Setting traps, sealing holes and cracks or other entry
points, and storing dry goods in plastic, sealable containers can help.
If these measures fail, you may need to consult a licensed pest control
professional.

Prevent mold. Mold in homes
is often caused by excessive moisture indoors. This can result from
water damage caused by flooding, leaky roofs, leaking pipes, or
excessive humidity. Repair any sources of water leakage. Control indoor
humidity by using exhaust fans in the bathrooms and kitchen and adding a
dehumidifier in areas with high humidity. The Environmental Protection
Agency (EPA) currently recommends cleaning existing mold with detergent
and water (though there may be debris that can continue to contribute to
allergic reactions). Some materials, such as wallboards with mold, have
to be replaced.

Reduce pollen exposure if your
child is allergic to pollen. Use an air conditioner in your
child's bedroom, with the fresh air vent closed, and leave doors
and windows closed during high pollen times. Seasons with high pollen
counts vary by region. Check with your allergist, local newspaper, or
the Internet for local pollen counts.

Check air quality reports.
When the air quality is very poor, keep your child indoors. Check
weather forecasts or the Internet for air quality reports.

What types of medicines are used?

Asthma is different in every child, and symptoms
can change over time. Your child's doctor will decide which asthma
medicine is best for your child based on how severe and how often your child has
symptoms. Medicines may also vary depending on your child's age.

Children with asthma whose symptoms occur once
in a while are given medicines only as needed and usually for short periods.
Children with asthma whose symptoms occur more often need to take a different
kind of medicine every day to control their symptoms. (See "Groups of
asthma medicines.")

Sometimes it's necessary to take several
medicines at the same time to control and prevent symptoms. Your child's
doctor may give your child several medicines at first, to get the asthma
symptoms under control, and then decrease the medicines as needed.

It usually helps to have an asthma
action plan or asthma home management plan written
down so you can refer to it from time to time. Such a plan should contain
information on daily medicines your child takes as well as instructions on what
to do when symptoms occur. A copy of the plan should also be provided to your
child's school or child care provider.

An example of an asthma action plan is available
on the National Heart, Lung, and Blood Institute (NHLBI) Web site at http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf.

Forms of asthma medicine

Asthma medicines come in a variety of forms,
including the following:

Metered-dose inhalers (MDIs)

Dry powder inhalers (DPIs)

Liquids that can be used in
nebulizers

Liquids that are taken by mouth

Pills

Inhaled forms are preferred because they
deliver the medicine directly to the air passages with minimal side
effects.

Groups of asthma medicines

There are 2 groups of asthma medicines:
quick-relief medicines and controller medicines.

Quick-relief medicines
are for short-term use to open up narrowed airways and help relieve
wheezing, breathlessness, and the feeling of tightness in the chest.
They can also be used to prevent exercise-induced asthma. These
medicines are taken only on an as-needed basis. The most common
quick-relief medicine is albuterol. These medicines relax the
muscles around the airways to open them up. Your child's
doctor may also recommend having an oral corticosteroid medicine
(pill or liquid) available should your child have a moderate to
severe asthma attack.

Controller medicines
are used on a daily basis to control asthma and prevent symptoms.
They act by reducing inflammation or by causing long-term relaxation
of airway muscles. Controllers are NOT used for immediate relief of
symptoms. Your child's symptoms will not get better
immediately after taking a dose of a controller medicine. Instead,
your child's symptoms should get better over a period of days
to as long as 2 weeks after starting a controller medicine. Children
with symptoms more than twice per week or who wake up from sleep
more than twice per month should be on controllers.

Controller medicines include the
following:

– Inhaled steroids
(Inhaled steroids are the most effective and thus the
preferred controller medicine for all ages. When used in
recommended doses, they are safe.)

– Long-acting
bronchodilators (for use only in combination products that
contain inhaled steroids)

– Leukotriene
receptor antagonists (available only in oral form)

– Other inhaled
medicines such as cromolyn

Speak with your child's doctor about
which controller medicine would be best for your child.

What devices are used to help deliver asthma medicines?

Medicines for asthma can be given to your child
using a variety of devices including the following:

Nebulizer. This device uses
an air compressor and cup to change liquid medicine into a mist that can
be inhaled. To be sure that the medicine gets into the lungs, controller
medicines and quick-relief medicines must be given with a mouthpiece or
mask.

An example of a nebulizer machine with mask
delivery.

Metered-dose inhaler (MDI).
This is the most commonly used device for asthma medicines. Spacers,
with an attached mask or mouthpiece, should be used to help make it
easier to use MDIs. Spacers should always be used with
inhaled steroids.

As of January 1, 2009, MDIs no longer
contain propellants that damage the ozone layer. The current inhalers
use a propellant gas that is safe for the environment and gives a
gentler, softer spray.

A meter-dosed inhaler (MDI).

Dry powder inhaler (DPI).
This device is available for some medicines. You don't need to
coordinate pressing with breathing with a DPI, but its use still
requires some training. It may have less taste and does not require the
use of a spacer. DPIs may be placed directly into the mouth for
inhalation of the medication. These devices vary in shape and size.

Because there are several different inhalers on
the market, your child's doctor will suggest the one that is best for
your child. There are important differences in the way they are used and amounts
of medicines they deliver to the airways. You and your child will be taught how
to use the inhaler, but your child's technique should be checked
regularly to make sure your child is getting the right dose of
medicine.

Exercise and asthma

Physical activity is important for your
child's physical and mental health. Children with asthma should be able
and encouraged to participate completely in physical education, sports, and
other activities in school.

Exercise can often trigger symptoms in children
with asthma. It can almost always be prevented with the use of quick-relief
medicines taken 10 to 15 minutes before exercise. If it occurs often, however,
it may mean your child's asthma isn't under control. Proper asthma
control can make a great difference in your child's ability to exercise
normally. It is important for parents to speak with their child's
physical education teachers and coaches about their child's asthma
management. If your child's asthma is interfering with your
child's ability to participate in physical activity, tell your
child's doctor.

Peak flow meter

A peak flow meter is a handheld
device that measures how fast a person can blow air out of the lungs. This
device may be recommended by your child's doctor to help monitor your
child's asthma; however, this handheld device does not give a detailed
assessment of asthma like a spirometer does (described earlier).

Asthma and schools

Children spend many hours at school, which is
why it is so important that asthma symptoms are well managed while they are
there. It's also important that you are aware of your child's
symptoms and any problems with how your child's asthma is managed in
school. The following are other things to keep in mind:

Good communication is important to asthma care and management in
school.

– Consider meeting with
your child's teachers, the school nurse, and coaches at
the beginning of the school year. The school needs to know about
your child's asthma, how severe it is, what medicines
your child takes, and what to do in an emergency.

– Ask your child's
doctor to complete an asthma action plan for the school, as well
as a medicine permission form that includes whether your child
should be allowed to carry and use his or her own inhaler and
instructions about use of a spacer with the inhaler.

– Sign a release at
school and your child's doctor's office to allow
the exchange of medical information between you, the school, and
your child's doctor.

– Ask the school official
or nurses about its policies on how your child will get access
to his medicines and how they deal with emergencies, field
trips, and after-school activities.

– Ask for updates if
necessary. The school should also inform you about any changes
or problems with your child's symptoms while your child
is at school.

Check for triggers at
school. The environment at school is as important as the
environment at home. Use the "How Asthma-Friendly Is Your
School?" checklist to check your child's school and
classroom. This checklist is available on the National Heart, Lung, and
Blood Institute Web site at http://www.nhlbi.nih.gov/health/public/lung/asthma/friendhi.htm.

Help your child cope with asthma
at school. Talk with your child about how well his asthma is
being managed in school. Also talk with your child's teachers,
school nurse, coaches, and other school personnel about how well your
child is coping with asthma in school.

The following are some problems students
with asthma may face at school:

Missing school because of asthma
symptoms or doctor visits.

Avoiding school or school
activities. Work with your child's doctor and school
personnel to encourage your child to participate in school
activities.

Not taking medicine before
exercise. Your child may avoid going to the school office or
nurse's office to use his inhaler before exercise.
Schools that allow children to carry their inhalers with them
can help avoid this problem. This is a good idea only if your
child always remembers to take his medicine and knows how to
take it properly.

Remember

Asthma is a complex yet treatable condition. By
using medicines, avoiding triggers and environments that can cause asthma
attacks, and carefully managing symptoms, children with asthma can lead normal
and healthy lives.

The following are some things to keep in
mind:

If you are concerned your child may have
asthma, talk with your child's doctor. Your child's doctor
may test your child's airway function. It is important to
remember that asthma is a difficult disease to diagnose, and the results
of lung function testing may be normal even if your child has
asthma.

Decreasing your child's exposure
to triggers will help decrease symptoms and the need for asthma
medicines.

There is no one magic medicine that
controls all asthma. Sometimes several medicines need to be taken at the
same time to control and prevent symptoms. Your child's doctor
will choose the best medicines for your child and talk with you about
when and how to use them.

It's important that asthma
symptoms are well managed while your child is at school.

If you have any questions about your
child's health, symptoms of asthma, or how your child's asthma is
being managed, talk with your child's doctor.

Listing of resources does not imply an
endorsement by the American Academy of Pediatrics (AAP). The AAP is not
responsible for the content of the resources mentioned in this publication. Web
site addresses are as current as possible, but may change at any time.

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